ActinicKeratosesNet Spotlight Article
How to Check for Actinic Keratoses (AKs) During Skin Self-Exam

For anyone who has spent years in the sun or frequently used tanning beds, regular skin exams are vital. Repeat exposure to ultraviolet (UV) rays, whether from the sun or tanning beds, can severely damage the skin. Over time, this damage can build up and cause actinic keratoses (AKs).

AKs appear on the skin as dry, scaly, rough-textured spots or patches. While most patients want AKs removed for cosmetic reasons, there is another reason to get them treated. AKs are considered the earliest stage in the development of skin cancer. Some AKs progress to squamous cell carcinoma (SCC), a type of skin cancer that can spread. Having AKs also increases the risk of developing other types of skin cancer.

The key to finding AKs and all types of skin cancer is regular skin exams. These exams help find AKs and all types of skin cancer in the earliest and most treatable form. Dermatologists recommend two types of skin exams — regular exams from a dermatologist and skin self-exams between appointments.

Dermatologists’ Tips for Finding AKs
Here are some tips to help find AKs during a skin self-exam:

1. Recruit a partner. You may want to ask a partner such as a spouse to help with the exam. A recent study found that people who involve a partner are significantly more likely to perform regular skin self-exams. A partner also makes it easier to examine areas such as the back and scalp.
    

2. Use the fingertips to find early AKs. AKs often can be felt before they are seen. To find AKs in their earliest form, run the fingertips over all skin weathered by years of sun exposure and showing signs of UV damage. Skin damaged by overexposure to UV rays tends to be dry, discolored, and wrinkled.
   
   When feeling for signs of early AKs, carefully examine skin that tends to receive years of sun exposure — face, ears, lips, scalp, neck, forearms, and backs of the hands.
   
   While running the fingertips over weathered skin, ask the following questions:

• Does any skin feel rougher than the surrounding skin? Pay close attention to the texture of the skin. Emerging AKs feel rougher than the surrounding skin, often like sandpaper, and may have a scaly or warty texture.
   

• How does the skin on the ears feel? The ears often receive years of unprotected sun exposure. Are there any rough spots on the ears?
   

• Does a lip feel scaly and dry? Does it tend to crack? These may be signs of an AK on the lip. Called “actinic cheilitis” when it develops on the lip, this lesion may cover a large area of the lip.

3. Look for visible signs of AKs on the skin. As AKs grow, they can be seen on the skin. Visible AKs tend to be skin colored or reddish. To spot visible AKs while examining the skin, ask:

• Are there spots or patches on the skin that resemble a red bump; scattered, thick red scaly patches; or crusted lesions varying in color from red to brown? AKs may appear in any of these forms.
   

• Does a growth on the skin resemble a horn? Sometimes an AK grows rapidly upward. When it does this, dermatologists call the growth a “cutaneous horn” because it resembles an animal’s horn. The size of a cutaneous horn may range from that of a pinhead to a pencil eraser; the horn may be straight or curved. Sometimes skin cancer hides beneath a cutaneous horn.

If a spot or patch resembles any of the above descriptions, be sure to contact a dermatologist. A dermatologist’s medical training makes this doctor uniquely qualified to diagnose the lesion and to decide if a lesion should be biopsied or treated.

References:
Robinson JK et al. “Examination of mediating variables in a partner assistance intervention designed to increase performance of skin self-examination.” Journal of the American Academy of Dermatology. 2007 March;56(3):391-397.